Elsevier

The Lancet

Volume 363, Issue 9417, 17 April 2004, Pages 1277-1281
The Lancet

Articles
Alcohol intake and risk of incident gout in men: a prospective study

https://doi.org/10.1016/S0140-6736(04)16000-5Get rights and content

Summary

Background

The association between alcohol consumption and risk of gout has been suspected since ancient times, but has not been prospectively confirmed. Additionally, potential differences in risk of gout posed by different alcoholic beverages have not been assessed.

Methods

Over 12 years (1986–98) we used biennial questionnaires to investigate the relation between alcohol consumption and risk of incident gout in 47 150 male participants with no history of gout at baseline. We used a supplementary questionnaire to ascertain whether reported cases of gout met the American College of Rheumatology survey gout criteria.

Findings

We documented 730 confirmed incident cases of gout. Compared with men who did not drink alcohol, the multivariate relative risk (RR) of gout was 1·32 (95% CI 0·99–1·75) for alcohol consumption 10·0–14·9 g/day, 1·49 (1·14–1·94) for 15·0–29·9 g/day, 1·96 (1·48–2·60) for 30·0–49·9 g/day, and 2·53 (1·73–3·70) for ≥50 g/day (p for trend <0·0001). Beer consumption showed the strongest independent association with the risk of gout (multivariate RR per 12-oz serving per day 1·49; 95% CI 1·32–1·70). Consumption of spirits was also significantly associated with gout (multivariate RR per drink or shot per day 1·15; 95% CI 1·04–1·28); however, wine consumption was not (multivariate RR per 4-oz serving per day 1·04; 95% CI 0·88–1·22).

Interpretation

Alcohol intake is strongly associated with an increased risk of gout. This risk varies substantially according to type of alcoholic beverage: beer confers a larger risk than spirits, whereas moderate wine drinking does not increase the risk.

Introduction

Gout is the most common inflammatory arthritis in men.1 The association between heavy alcohol consumption and increased risk of gout has long been suspected; however, the association has not been prospectively confirmed. Metabolic studies have shown that hyperuricaemia (not gout per se) can be induced by alcohol loading.2, 3, 4, 5 Furthermore, hyperuricaemia has been proposed as a marker for ethanol ingestion.5, 6 These findings provided the basis that alcohol might eventually cause gout through hyperuricaemia. Findings of several case-control studies7, 8 and a cohort study9 showed a significant association between alcohol consumption and gout, but these studies retrospectively ascertained alcohol consumption and did not adjust for potential confounders except for age. Prospective analyses have failed to confirm the association but have been limited by small sample size and lack of relevant variables.1, 10, 11, 12

Risk of gout could conceivably vary depending on type of alcoholic beverage (ie, beer, wine, and spirits), as does the risk of other diseases,13, 14 but no data are available. Findings of a case-control study suggested that the high purine content in beer might play an important part in the risk of gout augmenting the hyperuricaemic effect of alcohol itself.8 If different alcoholic beverages have different effects on risk of gout, this fact would have practical implications for gout prevention and management.

To examine these issues, we prospectively assessed the relation between total alcohol consumption and type of alcoholic beverage and risk of incident gout in a cohort of 47 150 men with no history of gout.

Section snippets

Study population

The Health Professionals Follow-up Study is an ongoing longitudinal study of 51 529 male dentists, optometrists, osteopaths, pharmacists, podiatrists, and veterinarians who were predominantly white (91%) and aged 40–75 years in 1986. The participants returned a mailed questionnaire in 1986 about diet, medical history, and medications. Of the 49 932 men who provided complete information on diet and age, 2782 (5·6%) reported a history of gout on the baseline questionnaire. These men were excluded

Results

During 12 years of follow-up, there were 730 newly diagnosed cases meeting American College of Rheumatology criteria for gout. The characteristics of the cohort according to alcohol consumption at baseline are shown in table 1. History of hypertension and diuretic use were slightly more common at higher levels of daily alcohol consumption. With increasing alcohol consumption, total meat intake increased slightly. Age, body-mass index, and other variables were similar across the categories of

Discussion

We prospectively assessed the long-suspected link between alcohol intake and incidence of gout in a large cohort of men. We validated the self-reported cases of gout by use of the American College of Rheumatology criteria19 and we found a strong association between alcohol consumption and incident gout. The risk of gout was significantly raised with alcohol intake as low as 10·0–14·9 g/day and the magnitude of the association rose with increasing intake. The risk of gout was 2·5 times higher

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